Otolaryngological-Speech Therapy approach to laryngeal neuropathy in children

Abstract

Laryngeal neuropathy (LN) is characterized by hypersensitivity, hyperresponsiveness, and laryngeal hyperfunction secondary to an imbalance between the afferent and efferent components. The individual and exaggerated response to a wide variety of specific triggers can lead to diverse symptoms. Literature in children is limited.

Objective: To report a case of laryngeal neuropathy in a 5-yearold girl, to discuss the approach from the otolaryngologist’s and speech therapist’s perspective and the importance of its consideration among the differential diagnoses of chronic cough in pediatrics.

Clinical Case: 5-year-old girl referred to otorhinolaryngology due to repeated crises of emetic cough with no specific cause identified. The episodes were associated with colds, choking sensation, and short-term inspiratory stridor. She was evaluated by several specialties. X-rays (nasopharynx, paranasal sinuses, and chest) and spirometry were performed without finding a cause or treatment that resolved the cough. In the ENT evaluation, possible triggers were identified such as having a sister with a congenital syndrome, exposure to perfumes, and air fresheners. Physical examination was normal. Flexible endoscopy shows incipient vocal fold nodules. After clinical suspicion of LN, she was referred to speech therapy for 5 weekly sessions. The patient received vocal hygiene education, cough suppression techniques, and breathing and relaxation exercises of the extrinsic and intrinsic muscles of the larynx with favorable results at 2 years of follow-up.

Conclusions: LN should be considered as a differential diagnosis of chronic cough in childhood when its most well-known causes and treatments do not lead to its resolution. The evaluation and speech therapy are the mainstay in the control of cough secondary to this entity in the pediatric age.